Spinal Extradural Cyst: Case Report and Review of Literature

Spinal extradural cyst (SEDC) accounts for <1% of spinal epidural lesions. It is commonly asymptomatic but can give rise to back pain and compressive neurologic symptoms.

We report the case of a 51-year-old male who presented with gait difficulties over 5 months associated with occasional urge incontinence. Clinical examination revealed signs suggestive of thoracic myelopathy with bilateral lower limbs spasticity, decreased proprioception, and pinprick sensation. Magnetic resonance imaging showed a thoracic (T) 7-T9 extradural cystic lesion with an area of flow void on the right side between T8 and T9. A right hemilaminotomy was initially performed, and the dural defect was identified and repaired primarily. Unfortunately, there was a recurrence of the SEDC 2 weeks post operation and a T7-T9 laminoplasty with a complete excision was performed.

Computed tomography myelography or magnetic resonance imaging flow study best visualizes the communication between the epidural cyst and subarachnoid space. The ideal surgical management for SEDC remains controversial. Our case suggests that there may be higher recurrence associated with fenestration of the SEDC and closure of the dural defect, but perhaps higher complications associated with complete excision. We present a case report and literature review of the terminology, presentation, recommended investigations, management, and outcomes of patients with SEDC.